Posterior wall isolation in persistent atrial fibrillation feasibility, safety, durability, and efficacy

René Worck*, Samuel K Sørensen, Arne Johannessen, Martin Ruwald, Martin Haugdal, Jim Hansen

*Corresponding author for this work


INTRODUCTION: Posterior wall isolation (PWI) added to pulmonary vein isolation (PVI) is increasingly used despite limited evidence of clinical benefit. We investigated the feasibility, durability, and efficacy of index-procedure PVI + PWI radio frequency ablation (RFA) in patients with persistent atrial fibrillation (PeAF).

METHODS AND RESULTS: Twenty-four patients with PeAF participated in the prospective PeAF-Box study and underwent RFA with wide area circumferential ablation, roof- and inferior lines to achieve PVI + PWI at index procedure. Follow-up included monitoring by an implantable cardiac monitor, esophagoscopy and mandated invasive lesion-reassessment at 6 months. PWI was achieved at minor procedural cost in all patients following PVI. In 33% of patients a median of three ablations in the narrow zone between the center of the posterior wall (PW) and the posterior right carina was pivotal for swift achievement of PWI. At the 6-month reassessment procedure 85% (95% confidence interval [CI]: 77%-92%) of pulmonary veins (PVs) and 46% (95% CI: 26%-67%) of PWs remained durably isolated. AF recurred in 25% and was associated with PV-reconnection (p = .02) but not PW-reconnection (p = .27). AF-burden was 0% (interquartile range [IQR]: 0%-0%) overall and after recurrence 1% (IQR: 0%-7%).

CONCLUSION: Index procedure PVI + PWI for PeAF was feasible when recognizing that limited ablation in a PW center-to-right-carina zone was required in a subset of patients. Despite limited chronic PWI durability this strategy was followed by low AF-burden. A PVI + PWI strategy appears promising in ablation for PeAF.

Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
Issue number8
Pages (from-to)1667-1674
Number of pages8
Publication statusPublished - Aug 2022


  • Atrial Fibrillation/diagnosis
  • Catheter Ablation/adverse effects
  • Feasibility Studies
  • Heart Atria/surgery
  • Humans
  • Prospective Studies
  • Pulmonary Veins/surgery
  • Recurrence
  • Treatment Outcome


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